Table 49.1.

Microbes that cause secondary immune deficiency states.

Microbe	Affected immunocyte	Immune dysregulation phenotype	Pathogens causing secondary infection	Abnormal lab tests associated with microbe infection
Viruses:
Measles	T Cells Dendritic cells	(1)Diminished lymphocyte proliferation (2)Decreased antibody production (3)Increased susceptibility to co-infection or super-infection with viral, bacterial or fungal pathogens	(1)Viral: Herpes simplex, cytomegalovirus, parainfluenza, adenovirus, coxsackie, respiratory syncytial virus (2)Bacteria: S. aureus, S. pneumonia, Klebsiella, Pseudomonas, mycobacteria, Acinetobacter (3)fungal: Candida	(1)Anti-measles IgM (2)Mitogen/Lymphocyte Proliferation Assay (3)Lymphocyte profile (T/B/NK cell immunocyte counts)
Influenza A Virus	Neutrophils	(1)Deactivation of chemotaxis, respiratory burst, degranulation, and bacterial killing (2)IFNs-γ, -α, -β triggered by IAV depresses macrophage function and macrophage scavenger receptor (MARCO) (3)Impaired murine chemokine recruitment of neutrophils to the lung	(1)Bacteria: Streptococcal pneumoniae, Staphylococcal (MRSA), Haemophilus influenzae pneumonia post Influenza A Virus infection	(1)PCR-based influenza assay (2)complete blood count with manual differential
Human Immune deficiency Virus (HIV)	CD4+ cells (T cells, macrophages)	Depletion of CD4+ T cells over time	Opportunistic infections: Bacteria, fungi, parasites	(1)4th generation HIV-1/2 Ag/Ab Assay (2)Lymphocyte count (T/B/NK immunophenotype)
Human T cell Lymphotropic Virus (HTLV)	T cells, NK cells	(1)induces cytotoxic T cells to kill virus-infected cells, (2)alter CD4+ T cell function and cytokine production (3)decreases NK cell activation	Strongyloides schistosomiasis	(1)HTLV-1 and HTLV-2 IgG/IgM (2)Lymphocyte count (T/B/NK immunophenotype)
Cytomegalovirus	T Cells	(1)lower frequency of naïve T cells and accumulation of memory T cells (2)immune senescence	Rare secondary bacterial/viral super infection	(1)CMV PCR (2)CMV IgG (3)Lymphocyte count (T/B/NK immunophenotype)
Epstein-Barr Virus	B Cells	(1)Depletion of B cells (X-linked lymphoproliferative syndrome (XLP)) (2)Monoclonal/polyclonal gammopathy (3)Autoimmunity (4)Cancer	Parvoviridae, Streptococcus group A.	(1)EBV DNA by PCR (2)Heterphile Ab (3)EBV Serology (EBV Viral capsid IgG/IgM, EBV early Antigen, EBV Nuclear Antigen) 4)Lymphocyte count (T/B/NK immunophenotype)
Parasites:
Leishmania	Macrophages	(1)Decreased MHC class II expression (2)Decreased IL-1 production	Bacteria that cause infection in patients with chronic granulomatous disease.	(1)Visualization of amastigote in smears or tissue (histopathology) (2)parasite isolation by in vitro culture (3)molecular detection of parasite DNA (4)serologic testing
Malaria	T Cells Dendritic cells	(1)Impaired dendritic cell maturation and activation (2)Increased susceptibility to co-infection with viral and bacterial pathogens (3)Decreased efficacy of heterologous vaccines (4)Reactivation of existing Epstein-Barr infection, with increased susceptibility to develop lymphoma	(1)viral: Herpes zoster, hepatitis B, Moloney leukemia virus, Epstein-Barr virus (2)bacterial: Salmonella	(1)Light microscopy - Giemsa stained blood smears (2)Rapid diagnostic test – antigen based assay (HRP2, pLDH, aldolase) (3)PCR based confirmation for research and epidemiological uses (4)Lymphocyte count (T/B/NK immunophenotype)
Bacteria:
Bordetella Pertussis	Airway macrophages, neutrophils	(1)Delay of neutrophil recruitment and influx into airways (2)Depletion of airway neutrophils	Pyogenic bacterial and mycoplasma pneumonia	(1)culture - ciliated respiratory epithelium posterior nasopharynx (2)polymerase chain reaction (PCR) – polyester/ rayon swab - ciliated respiratory epithelium of posterior nasopharynx (3)Serology of pertussis antibodies (IgA or IgG to pertussis toxin, filamentous hemagglutinin, pertactin, fimbriae, or sonicated whole organism) acutely versus 4 weeks later